It ain’t what you do, it’s the pace that you do it…
Posted in Journal Reviews on 23rd Jan 2015
Reviewer – Dr Lloyd Bradley, Consultant in Rehabilitation Medicine, Western Sussex Hospitals NHS Foundation Trust, UK
There is an unwritten law of rehabilitation research that the more obviously beneficial an intervention, the harder it can be to identify a good evidence base. Is it better for Speech Therapists to conduct therapy sessions using the same language as the patient they are working with? Are the outcomes for hydrotherapy better in warm rather than freezing water? No, I don’t know either. There’s no evidence to say so, we just assume.
There is certainly a lot of research around the levels of physical activity within inpatient rehabilitation units. Perhaps unsurprisingly many patients are observed to spend significant amounts of time being physically inactive in spite of the fairly well evidenced(!) benefits of physical activity in a number of different domains. Engaging in social interaction is also felt to be important in the context of rehabilitation, but with a significantly less-well developed evidence base. The researchers begin this interesting study of the effects of environment on stroke recovery with reference to animal models. Although there is probably something to be said for drawing analogies around neuronal remodelling and cellular changes from mouse models of stroke, determining what constitutes an ideal environment for social activity from murine preferences is probably a less secure paradigm. The idea of an “enriched environment” is a fairly nebulous one but most of us would intuitively feel there is value in a setting that promotes social interaction and cognitive activity.
In order to determine the benefit of an “enriched environment” two (fairly small) groups of stroke patients within an inpatient neurorehabilitation facility were compared. One group were given access to communal activities and individual opportunities for stimulation such as newspapers, games consoles, board games, music and books. The other group received “standard care” (one wonders how rigorously the control group could be denied personal stimulation). Predictably the experimental group spent significantly more time engaged in “activity” than the control group. Unfortunately there is no longitudinal data around the effect that engaging in this activity may have had on length of stay or more meaningful functional outcomes.
No one working within an inpatient care setting can fail to appreciate how the traditional ward environment of being in a bed ministered to passively promotes dependence and adversely affects engaging in the normal activities of daily living. While perhaps animal models are not the best sources of information for the benefits of environmental stimulation in human populations, there are clearly many unanswered questions around the optimum environment for rehabilitation to take place in. Promoting independent social activity and interaction, may, in the end be as important as the regimental daily 45 minutes of face-to-face contact with a therapist in facilitating longer term gains. It is heartening that the focus could switch back to the patient “doing” rather than being “done to” in promoting recovery.
Janssen H, Ada L, Bernhardt J, McElduff P, Pollack M, Nilsson M, Spratt NJ. An Enriched Environment Increase Activity in Stroke Patients Undergoing Rehabilitation in a Mixed Rehabilitation Unit: A Pilot Non-Randomised Controlled Trial. DISABILITY AND REHABILITATION 2014;36(3):255-62.
ACNR 2015;14(6);18. Online 23/01/15Download this Article